CHISLEHURST AND SIDCUP URBAN DISTRICT COUNCIL ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE HEALTH OF THE URBAN DISTRICT 1950 Printed by Strong & Sons, Ltd,, 22, North Street, Bromley, Kent. 1 CONTENTS. PAGE Members of the Health Committee.3 Staff 3 Prefatory Letter4 SECTION A. VITAL AND OTHER SOCIAL CONDITIONS. Vital Statistics 8 Population 9 Births 9 Illegitimate Births 9 Stillbirths 9 Deaths 10 Infant Deaths 10 Maternal Mortality 10 Unemployment 10 Open Air Recreational Amenities 11 SECTION B. SUMMARY OF HEALTH SERVICES FOR THE AREA. Hospitals 14 Health Visiting 15 Midwifery (Domiciliary) 15 Home Nursing Service 15 Domestic Help Service 15 Child Welfare Centres 16 Clinics 16 Ambulance Service 16 Laboratory Service 17 Day Nurseries 17 Medical Loan Depots 17 St. John Ambulance Brigade 17 Old People's Clubs 17 Old People's Welfare Committee 18 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. Water Supply 22 Drainage and Sewerage 23 Cesspools 23 Rivers and Streams 23 Swimming Baths 23 SECTION D. FACTORIES, OUTWORKERS, ETC. Factories 26 Smoke Abatement 26 Shops Act 26 Rodent Control 27 Verminous Conditions and Uncleanliness 28 SECTION E. HOUSING. New Houses 30 Rehousing by Local Authority 30 Moveable Dwellings 30 Overcrowding 31 2 SECTION F. INSPECTION AND SUPERVISION OF FOODS. PAGE Inspection of Food Premises 34 Food and Drugs Act, 1938-1950 34 Unsound Food 34 Complaints 35 Slaughterhouses 35 Butchers' Shops 35 Piggeries 35 Bakehouses, etc 35 Fishmongers and Fish Frying premises 35 Milk 35 Ice Cream 36 SECTION G. INFECTIOUS DISEASES. Anterior Poliomyelitis 38 Smallpox 39 Vaccination 40 Scarlet Fever 40 Diphtheria 40 Diphtheria Immunisation 40 Measles 41 Whooping Cough 41 Tuberculosis 42 Food Poisoning 42 Dysentery 43 Summary of Infectious Diseases notified 43 SECTION H. OTHER SERVICES. Inspection of Nursing Homes 46 Health Education 46 Public Conveniences 47 Public Mortuary47 APPENDIX—STATISTICAL TABLES. Table 1.—Sanitary Inspection—Inspections and Complaints 50 „ 2.—Factories Acts 51 „ 3.—Food and Drugs Sampling 53 „ 4. Unsound Food 55 „ 5. Water Supply 57 „ 6. Tuberculosis Rates 58 „ 7. Tuberculosis—Summary of Quarterly Returns, 1950 59 „ 8. Tuberculosis—Age Groups, 1950 60 „ 9. Parks and Open Spaces 61 3 PUBLIC HEALTH COMMITTEE Chairman: E. O'SULLIVAN, Esq. Vice-Chairman: F. C. CARTER, Esq. CHAIRMAN OF THE COUNCIL. VICE-CHAIRMAN OF THE Mrs. 1. BROOK. COUNCIL K. E. CARTER, Esq. G. C. ODLING, Esq. Mrs. F. J. DAUBNEY. P. A. SHAW, Esq. Miss B. H. JAMES, J.P. Mrs. E. V. WALLACE. P. V. NASH, Esq. W. T. WALLIS, Esq. W. WILLIAMS, Esq. STAFF OF THE HEALTH DEPARTMENT as at 31.12.50. Medical Officer of Health. K E. TAPPER, O.B.E., G.M., M B., Ch.B., D.P.H. Deputy Medical Officer of Health. H. B. C. CARTER-LOCKE, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary and Shops Act Inspector. A. V. B. ALLEN, M.R.S.I., M.R.I.P.H.H., M.S.l.A. Deputy Chief Sanitary and Shops Act Inspector. J. C. KERMODE, C.R.S.I., M.S.I.A. District Sanitary Inspectors. E. C. BERWICK, C.R.S.I., M.S.l.A. D. W. FOSTER, M.R.S.I., M.S.l.A. J. W. P. HARRIS, C.R.S.I., M.S.l.A. Clerical Staff. W. J. WATLING Miss C. DEVONSHIRE Outdoor Staff. T. BACK (Disinfector, Mortuary Keeper, Drain Clearer and General Handyman). T. CONNOR (Assistant to Mr. Back) A. ELLIS (Rodent Operative) 4 To the Chairman and Members of the CHISLEHURST & SIDCUP URBAN DISTRICT COUNCIL. Mr. Chairman, Ladies and Gentlemen, This is my third Annual Report to you and the seventeenth since Chislehurst and Sidcup became an Urban District in 1934. The vital statistics for the year 1950 indicate improvement in the state of the health of the residents. A birth rate of 15.0, a death rate of 8.5, and an infant mortality rate of 23.3, are good when compared with the country as a whole, as one would expect them to be in a delectable residential area such as Chislehurst and Sidcup. It has been stated that the improvement in the vital statistics during the past three years has been due to the functioning of the National Health Service Act, 1946, but, in my opinion, the main causes of these improvements lie in full employment and increase in the spending power of the family, causes which were so strongly indicated during the war years following 1941 when full employment, development of meals and milk in schools, and a controlled national dietary were established by the Government. I was able to show this in the case of the school child of Bromley when the average height was increased by half an inch and the weight by one-and-a-half pounds compared with the pre-war child of 1938. Accepting vital statistics as a means of assessment of public health is rather outmoded and one can easily be led astray unless one also has access to the sickness rate and to the nature and length of the sickness. I have not these latter figures. The London County Council St. Paul's Cray Estate was almost complete at the year's end and this great influx of London residents into your static population will be apt to upset the balance of your vital statistics for a few years to come. Take one factor alone ; in the selection of tenants for the new estate, the London County Council give preference—and rightly so— to families with tuberculosis. The percentage of such families allocated accommodation is approximately twelve per cent, of the whole. As these families are usually sub-standard in health, there is, thus, a proportionate increase of them in your population. The effects of this may not show themselves immediately, nor are the effects in any way likely to become a permanent feature. Your ratio of children to the total population is also made higher than your neighbouring authorities owing to families with children being given high priority for housing. When large estates are being developed, there is, unfortunately, delay in the establishment of social services. To take large numbers of people from one environment where they know and use the social facilities, to an environment where social services are lacking, leads to 5 unrest, complaints and often family unhappiness. The building of shops, halls, cinemas, churches, schools and welfare and other clinics should proceed pari passu with the building of the houses. The housing of London's population within your area is another case of history repeating itself. In the years between 1800 and 1860 the population remained comparatively static. In the sixties a sudden spread of London's population caused your population to be actually doubled and it is of some interest to note too that the population even in those days preceded the transport facilities. There is evidence also that the movement out of London was based upon the desire for better health, better housing and the desire to be away from the horrors of the slums of the London of those days. The staff of the Department has remained unchanged during the year and there have been no changes in the functions of the Department. It is regrettable that an experienced Local Authority with a population of 80,000 persons has no real executive part in the functions of the National Health Service Act. There have been no acute infectious disease epidemics during the year. Diphtheria continues to be noted for its absence, scarlet fever is mild in character, measles and whooping cough widely spread, but there were no deaths nor were the infections accompanied by complications. I am again indebted to Mr. Allen and the staff for their loyal co-operation throughout the year and for their help in the compilation of this report. I have the honour to be, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. 7 SECTION A VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA 8 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The Urban District of Chislehurst and Sidcup, comprising 8,957 acres, was formed in 1934, and now has a total population of 80,040— approximately 8.94 persons per acre—which is an indication of the open nature of this district. There are a number of Commons, Parks and Open Spaces, a list of which will be found in Appendix 9. The main administrative centre is picturesquely situated at Sidcup Place, which is easily accessible. At the present time some branches of the Council's work are conducted from centres remote from Sidcup Place, but now that the Council has acquired Manor House, it is only a matter of time before all offices will be centralised. Summary of Vital and Other Statistics. Area (in acres) 8,957 Registrar General's estimate of total population (mid-year, 1950) 80,040 Number of valuation assessments of habitable premises at the close of the year (approx.) 22,043 Number of valuation assessments of habitable premises at the close of the year 1950 in respect of:— (a) Houses 21,000 (b) Flats 1,000 (c) Farmhouses 17 (d) Public Houses (incl. Beerhouses) 26 Rateable Value (31st March, 1950)£675,433 Product of a Penny Rate, year ending 31st March, 1951 £2,670 Live Births. Total Male Female Legitimate 1,166 624 542 Birth rate, 15.0 per 1,000 population. Illegitimate 35 14 21 1.201 638 563 Stillbirths. Total Male Female Legitimate 25 14 11 Stillbirth Rate, 20.4 per 1,000 live and still births. Illegitimate — — — 25 14 11 Deaths. Total Male Female Death Rate, 8.5 per 1,000 population. 682 351 331 Deaths from Puerperal Causes. Puerperal Sepsis Nil. Other Maternal Causes Nil. Nil. 9 Deaths of Infants under one year of age. Total Male Female Infant Mortality Rate, 23.3 per 1,000 live births. Legitimate 28 15 13 Illegitimate — — — 28 15 13 Death Rates of Infants under one year of age. All Infants per 1,000 live births 23.3 Legitimate Infants per 1,000 legitimate live births 23.3 Illegitimate Infants per 1,000 illegitimate live births — Population. The rapid yearly increase of the population has been due to the influx of tenants to the London County Council Housing Estate at St. Paul's Cray, and it now rests with the Local Authority and Voluntary Associations to mould these tenants into being recognised residents of Chislehurst and Sidcup. This influx of young families has made an increase in the proportion of child to adult population. The social services must also be organised to cope with this factor. The excess of births over deaths during 1950 was equivalent to 6.5 persons per 1,000 population, a factor which also affects the housing programme. Births. The Birth Rate for 1950 is 15.0 per 1,000 population (15.8 for 1949). The Registrar General's figures, after correction for inward and outward transfers, give a total of 1,201 live births, of which 1,166 were legitimate and 35 illegitimate. In addition to these live births, 25 pregnancies ended in stillbirths. I have no record of the number of pregnancies that ended in abortion, nor a true figure of the births that occur in Hospitals, Nursing Homes, or at home, for, unfortunately, Local Authorities do not now receive the notifications of births. The fall in the Birth Rate is insignificant. Illegitimate Births. The illegitimate birth rate, for 1,000 live births, for 1950, was 29.1, compared with 40 in the previous year. This always shows a yearly wide variation, but a rate of 29 per 1,000 live births is below the average for the past seventeen years. Stillbirths. The stillbirth rate for the year was 20.4 per 1,000 (live and still) births, and is slightly higher than that for 1949, which was 17.8. 10 Deaths. Six hundred and eighty-two deaths were recorded during the year, giving a Death Rate of 8.5 per 1,000 population, which is slightly higher than the previous year. Of this figure, 351 were males and 331 females. following table shows the mam causes of death: — 1949 1950 Cancer 102 131 Respiratory Diseases (not Tuberculosis) 55 59 Heart and Circulatory Diseases 257 330 Tuberculosis 35 30 Infectious Diseases 15 8 Road Traffic Accidents 7 5 Other Violent Causes 11 12 Suicide 4 7 Digestive Diseases 13 18 Other Causes 83 82 582 682 The slight fall in the number of deaths from Tuberculosis is a welcome sign as is the fall in deaths from infectious diseases. There was one death from Infantile Paralysis and five from Influenza. There were no deaths from Diphtheria, Scarlet Fever, Measles or Whooping Cough. The deaths from Cancer indicate the organs primarily affected to be: Stomach 14, Lungs 31, Breast 11, Uterus 5 and other malignant and lymphatic neoplasms 70. There were 76 deaths from Coronary disease, angina, and 11 deaths from Hyper-plasia of prostate. Infantile Mortality. The Infant Mortality Rate for the year is 23.3 per 1,000 live births. Twenty-eight infants died during 1950 before reaching their first birthday, fourteen dying within the first four weeks of life, eight of them having congenital malformations. Maternal Mortality. There were no maternal deaths in the Urban District during the year 1950. Unemployment. I am indebted to the Manager of the Local Labour Exchange for the following information: — Considering the size of the population, the percentage of unemployment remains small, despite the increase over 1949. For the able-bodied man, not too old, there is plenty of work both locally and in adjacent areas, or in London. 11 Women workers, provided they have good eyesight and nimble fingers, are required in numbers, both on a part-time as well as a fulltime basis. The demand for resident domestics is never fully met. Unemployment remains, with the men, mainly among those who are not fully fit or are getting on in years—and among women with those who impose conditions as to hours of employment which are impracticable or uneconomic from an employer's point of view. Open-Air Recreational Amenities. Chislehurst and Sidcup are very fortunate in the number of openair recreational amenities in the district, for there are few things more refreshing both for the body and mind than the ability to be able to get away, even if only for an hour or so, from the turmoil and stress of modern city life. The Council, by its wise provision of these amenities, has given everybody a chance of enjoying the peace and quiet of the open spaces and thereby made a great, if unspectacular, contribution to the health of the populace. There is, however, the extraordinary anomaly that on fine Saturday morning one sees children queueing for admission to cinemas. In Appendix 9 will be found a list of Commons, Parks and Open Spaces. 13 SECTION B SUMMARY OF HEALTH SERVICES FOR THE DISTRICT 14 SECTION B. SUMMARY OF HEALTH SERVICES FOR THE DISTRICT I have sub-divided the services into services rendered by the Council, services rendered by the Hospital Boards, services rendered by the County Council under Part III of the National Health Service Act, 1946, and Voluntary Services. 1. Public Health Services Rendered by the Council. One of the major services of the Health Department and, one might add, one for which Sanitary Inspectors were first appointed, is to deal with complaints and the abatement of nuisances. A number of these are discovered by routine inspection of the district, but the great majority are brought to our notice by members of the public. It is pleasing to note that of the 1,175 complaints received during the year, it was necessary only in eighteen cases to take recourse to legal action to secure an abatement of the nuisance. These figures undoubtedly pay tribute to the tact and discretion of the Inspectors, and to my mind are an indication of good liaison with the public generally. One of the essentials in the provision of this service is for the officers of the department to be situated where they are easily accessible to any member of the public. The major services of the Public Health Department, to which detailed reference is made under Sections C., D., E., F., G., and H., of this report, are as follows : —- Infectious Diseases (Prevention and Notification). Inspection of Food and Food Premises. Inspection and Examination of Water and Milk Supplies. Inspection of Factories and Shops. Housing. Inspection of Nursing Homes. Rodent Control. Atmospheric Pollution. Health Education. Public Mortuary. All matters covered by the general heading of Sanitary and Environmental services. In the Appendices (Nos. 1—4) is a summary of the work of the Sanitary Inspectors. 2. Services Rendered by the Hospital Boards. There are three hospitals in Chislehurst and Sidcup: Queen Mary's Hospital with 510 beds, Cray Valley Hospital with 31 beds, and Sidcup Cottage Hospital with 14 beds, giving a total of 555 hospital beds available in the district. They form part of the Sidcup and Swanley Hospital Group of the South East London Region. There are ten maternity beds in the Cray Valley Hospital. 15 In addition to these hospitals, six blocks of Grove Park Hospital lie within the Chislehurst and Sidcup Urban District. One of these blocks is given over to Mass Radiography. In the remaining five blocks there are 291 beds given over to cases of tuberculosis. They form part of the Woolwich Hospital Group. 3. Services Rendered by the County Council. Health Visiting. The County Council employ ten Health Visitors to work in Chislehurst and Sidcup. Their main function is to give domiciliary advice in the care of mother and child, to attend welfare centres and school clinics and school medical inspections. They follow up and advise on immunisation against Diphtheria and vaccination against Smallpox. Midwifery (Domiciliary). There are nine midwives engaged whole time on domiciliary midwifery. They are engaged either by the patient direct, or through the latter's Doctor, and act either as midwives or maternity nurses. Home Nursing Service. There are twelve Home Nurses in the Chislehurst and Sidcup area who attend patients in their own homes on certification of the need by a doctor. Domestic Help Service. Below is a summary of the cases assisted in Chislehurst and Sidcup during the year: — Types of Cases Jan Feb Mar Apl May Jne Jly Aug Spt Oct Nov Dec Total Lying-in 5 13 13 16 8 11 7 3 9 5 3 6 99 Ambulant Expectant Mothers 2 2 3 2 2 2 2 1 4 2 1 2 25 Bedridden 3 4 4 2 3 1 — — 1 — 1 1 20 Aged Ambulant 36 33 36 33 33 31 33 32 39 37 45 43 431 Bedridden 31 34 34 36 31 28 31 27 29 27 26 28 362 Tuberculosis Ambulant 9 9 10 12 6 4 3 4 3 3 4 4 71 Bedridden 12 15 19 20 10 10 10 9 11 11 9 8 144 Other Cases Ambulant 38 30 31 34 22 24 18 19 20 19 18 19 292 Bedridden 17 20 24 36 22 21 18 19 19 20 17 18 251 Totals 153 160 174 191 137 132 122 114 135 125 124 129 1,695 Number of Part-time Domestic Helpers 102 Number of Full-time Domestic Helpers 3 16 Child Welfare Centres. CHISLEHURST: The Willows, Red Tues. and Thurs., p.m. Hill Test Feeds, Tues. a.m. FOOTSCRAY: W. Smith Memorial Hall Tues., p.m. MOTTINGHAM: Kimmeridge Road Mon. and Wed., p.m. SIDCUP: The Oval, Sherwood Park Avenue Tues., Wed. and Fri., p.m. Congregational Church Hall Mon. and Wed., p.m. NORTH CRAY: Social Club, North Cray Road 1st and 3rd Fri. p.m. Ante-Natal Clinics. CHISLEHURST: The Willows, Red Hill Wed., p.m. MOTTINGHAM: Kimmeridge Road Mon. and Wed., a.m. SIDCUP: The Oval, Sherwood Park Avenue Tues. and Fri. a.m. Congregational Church Hall Wed.. a.m. Thurs. p.m. Women's Welfare Clinics. CHISLEHURST: The Willows, Red Hill Tues., a.m. MOTTINGHAM: Kimmeridge Road 1st Thurs., 1.30 p.m. SIDCUP: The Oval, Sherwood Park Avenue 3rd Thurs.. p.m. Congregational Church Hall 1st Thurs., a.m. 3rd Thurs., a.m. Post-Natal Physiotherapy. Classes for post-natal exercises are held each week on Thursday evening, at Days Lane Primary School, Sidcup. These classes are in charge of a Physiotherapist. Minor Ailment Clinics (Schools). CHISLEHURST: The Willows, Red Hill Sat. a.m. MOTTINGHAM: Kimmeridge Road 2nd and 4th Sat., a.m. SIDCUP: Longlands School, Wood- side Road 1st Sat., a.m. 10, Station Road Every week-day 10.30-11.30 a.m. 1.30- 3.0 p.m. Dental Clinics. The Willows, Red Hill, Chislehurst Thurs., Fri., Sat. a.m. Kimmeridge Road, Mottiingham Wednesday. All day. Baptist Church Hall, Sidcup Mon., Tues. All day. Immunisation and Vaccination. These services are carried out at Child Welfare Centres, and at "Charmouth," Elm Road, Sidcup, on Tuesday afternoon. Ambulance Service. There is an ambulance depot at the Council Offices, Main Road, Sidcup, where there are four ambulances and three sitting-case cars. It is locally administered through the District Officer stationed at 2, Alma Road, Sidcup. 17 Laboratory Service. Routine medical specimens and food and drugs samples are examined at Maidstone Laboratory. Day Nurseries. Until December, 1950, there were three day nurseries in the Chislehurst and Sidcup area, situated at Days Lane, Sidcup; 67-69, Sidcup Hill; and Kimmeridge Road, Mottingham, accommodating a total of 180 children, but at the end of the year, the Kimmeridge Road nursery closed down. 4. Services Rendered by Voluntary Associations. Medical Loan Depots. A full range of nursing requisites is available at the Medical Loan Depots. Application for loan of such equipment for Chislehurst and Sidcup inhabitants should be made to: — The Manor House Hall, Sidcup Green Tues., 3—4 p.m. Thurs., 7—8 p.m. 56, Woodside Avenue, Chislehurst Mon., 3—4 p.m. Thurs., 6.30—8 p.m. 51, Framlington Crescent, Mottingham Wed., 6—7 p.m. Chislehurst and Sidcup Tuberculosis Care Committee. This Committee, which has been in existence since 1938, is very active in its functions and is doing very useful work in helping people suffering from tuberculosis. In addition to their interest in the care of persons suffering from this disease, and their families, they also take a keen interest in the prevention of the disease. The main functions of this Committee are to provide financial and clothing assistance, where necessary, and diversional therapy and social visiting. The St. John Ambulance Brigade. The objects of the Brigade are to afford holders of first aid certificates from the St. John Ambulance Association opportunities of meeting together for ambulance and nursing practice, with the object of combining individual efforts for the public advantage ; to render first aid to the sick and injured on public occasions, with the sanction of the police and other authorities, and to maintain in readiness for such duty a body of trained men and women. Old People's Clubs. There are eleven Old People's Clubs in Chislehurst and Sidcup, details of which will be found in the abstract from the report of the Old People's Welfare Committee. These clubs do much to dispel the boredom and loneliness which might otherwise hasten the deterioration of the mental and physical health of elderly people. They have proved their value in giving old people opportunities to meet their own contemporaries at a place where they can be sure of a 18 warm welcome and friendship. It may well be that, in the case of a good many elderly people, the days of the Club's meeting are red letter days in what is otherwise a monotonous and lonely life. Chislehurst and Sidcup Old People's Welfare Committee. Abstract from Secretary's Annual Report: — "The year 1950/51 has seen the opening of four new Clubs: the 'Home from Home' Club in Days Lane, the 'Good Companions' Club, a new branch of the 'Jolly Rogers' Club in Wren Road; and the 'Rodney Old People's Club' on the St. Paul's Cray L.C.C. Estate. This brings the total number of Clubs in the district to eleven, apart from the O.A.P.A. groups in Sidcup, St. Paul's Cray, Chislehurst and Blackfen, and the Pavilion in Marlborough Park, which is used daily by twelve elderly men. The average attendance of members at Clubs is as follows: — The Cosy Club 80 The Friendly Club 35 The Jolly Rogers' Club (Davenport Road) 30 The Jolly Rogers' Club (Wren Road) 50 The Merry and Bright Club 50 The Sunshine Club 45 The Home from Home Club 45 The Good Companions Club 40 Blackfen W.V.S. Club 200 Mottingham W.V.S. Club 30 Rodney Club, L.C.C. Estate (open daily) 99 The total average attendance is approximately 700. We need another Club in Footscray, but, as yet, we have found no leader to take the responsibility. Inter-Club Activities. Eight hundred old people were entertained at the Summer Rally held in June, at Sidcup Place. Despite the rain which fell continuously, and the extreme difficulty of serving tea under such conditions, the old people thought it a great success. A concert was given to combined Clubs early in the Autumn. A Handicraft competition was organised in October. One hundred and eighty members entered work in the competition and the standard of work was exceedingly high. The fourth Inter-Club Bulb competition was held in February, and all Clubs and Club helpers entered. There was keen rivalry among the competitors. Infirm Wards, Queen Mary's Hospital, Sidcup. Close contact is established with the two Wards for the infirm and elderly patients, some of whom have entered for the handicraft and bulb competitions. Two patients were among the prize-winners. Rotary and Toc H have been most kind in wheeling out patients and transporting the stronger ones to the Summer Rally in Sidcup Place. 19 Holidays. The Committee's first holiday scheme was launched this year, and eighty-four members from various Clubs enjoyed a week's holiday at Bexhill at the low fee of £2 12s. 6d., excluding fare. The members travelled all together by coach. The scheme was a great success. All the hotel and boarding house proprietors made every effort to make the week's stay really happy and comfortable, and the old people were very appreciative of all the kindness shown to them. It is hoped that an even greater number of members will be able to participate in the scheme next year. Visitors' Panel. During the year, a visiting panel has been formed to cover most of the Urban District." The Chairman of this Committee is Councillor Miss B. H. James, J.P., and the Secretary, Mrs. A. L. Arlidge, 21, Selborne Road, Sidcup. British Red Cross Society. The Chislehurst and Sidcup division of the British Red Cross Society has detachments at Chislehurst, Sidcup (2), Mottingham, and also at Petts Wood and Orpington (serving the St. Paul's Cray L.C.C. Estate), with cadet units and associate groups. The Divisional Office is at Hornbrook House, High Street, Chislehurst. The objects of this Society are the care of the sick and wounded in peace and war, the improvement of health, the prevention of disease and the mitigation of suffering. In addition to first aid duties and regular auxiliary nursing in the hospitals of the neighbourhood, the men and women of the Society's detachments are engaged in a number of local welfare activities which include the Hospital Library Service, diversional therapy for the home-bound, home visiting of the sick, hospital needlework and hopfield dispensaries. A first aid hut is open at Ruxley Corner, Footscray, on Sundays and public holidays during the summer, and four depots are operated at all times for the loan of invalid and sick room equipment. Personnel assist in staffing at local clinics and at the periodical blood transfusion sessions. The division is responsible for the recruitment and initial instruction of untrained volunteers for the National Hospital Service Reserve, and undertake the basic first aid training of volunteers for the Civil Defence Corps. Membership of the adult detachments is open to men and women between the ages of sixteen and sixty-five. 21 SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES F 22 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES Water Supply. I am indebted to the Director of Water Examination, Metropolitan Water Board, for the following statement and for the details of analysis of water supplies, which are set out in Appendix 5. "The supply to the district of Chislehurst and Sidcup has been adequate at all times in 1950 and is derived from the following seven wells: Orpington, North Orpington, Shortlands, Eynsford, Bexley, Wilmington and Darenth, together with Thames-derived filtered water via Shortlands Pumping Station. Bacteriological analyses of samples of water at the various stages of purification of these sources of supply are made at least five times a week and consistently satisfactory results have been obtained. Chemical analyses of the samples are also made at frequent intervals. All supplies are treated with chlorine at the works, but any excess chlorine remaining after a period of contact is removed completely or reduced to an amount that will not be perceptible to consumers. Tanks have been installed at North Orpington, Bexley and Wilmington to ensure an adequate period of contact of chlorine with the water; tanks at other well stations are planned or are in the course of construction. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are analysed to establish that it is up to the normal standard of quality expected in the distribution system. None of the supplies is plumbo-solvent. We have no information with regard to the proportion of the total number of dwelling houses and population in Chislehurst and Sidcup which are supplied from each of the above-mentioned sources. All the houses are supplied directly and not by means of standpipes." The following information has been supplied by the Clerk to the Metropolitan Water Board: — "No new source of public water supply has been instituted in the Council's area during 1950. There have been no extensions of trunk mains. Further lengths of service mains have been laid on the London County Council St. Paul's Cray Estate and Edgebury Estate. Several other short extensions have also been laid. The water supply has been satisfactory as regards quantity. There are now only three premises with water supplied from private wells." 23 Samples were taken from premises in the district, with the following results: — Satisfied Test. Did not satisfy test. (a) Chemical Examination 29 — (b) Bacteriological Examination 31 — Drainage and Sewerage. Main drainage is under the control of the West Kent Main Sewerage Board. During the year under review the sewerage constructed was as follows: — London County Council Estate, St. Paul's Cray.—A total of 17 miles of soil and surface water sewers have been constructed. Edgebury Estate.—A total of 3,846 linear yards of soil and surface water sewers have been completed. Cesspools. There are 482 premises in the district not drained to sewers. Ten have chemical closets, seven have earth closets and the remainder are drained to cesspools. Owners or occupiers of premises make private arrangements with a Maidstone firm for emptying cesspools. The charge is 23s. for the first 1,000 gallons, and 20s. for each subsequent 1,000 gallons of sewage emptied. Of the 465 premises with cesspools, five are within legal distance for conversion to main drainage. There are some ten cesspools which, although in the line of the sewer, it is not possible to connect owing to the level. The balance will remain until such time as main drains can be established. At the present moment, the scheme for main drainage at Leesons Hill is being formulated. Seven new houses were erected in 1950 with cesspool drainage, three of which have since been connected to the sewer. Rivers and Streams. Thirteen inspections have been made during the year. The Kent River Board has made a start on the improvements of the main river in St. Paul's Cray, as proposed, between Station Road, St. Paul's Cray, and the Sidcup By-Pass. For part of its length between these points, Cray River is being diverted into a new concrete channel. Swimming Baths. There is one small private swimming bath in the district to which the public are admitted. Samples are taken regularly and if and when they have been unsatisfactory, immediate remedial action has been taken. 25 SECTION D FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL AND VERMINOUS CONDITIONS AND UNCLEANLINESS 26 SECTION D FACTORIES, OUTWORKERS, SMOKE ABATEMENT, SHOPS ACT, RODENT CONTROL AND VERMINOUS CONDITIONS AND UNCLEANLINESS. Factories. The supervision of factories is partly in the hands of the Factory Inspectors of the Ministry of Labour and National Service and partly in the hands of Local Authorities. Factories having mechanical power are largely the responsibility of the former and factories without mechanical power, the latter. In both cases the adequacy and efficiency of the sanitary accommodation is dealt with by the Local Authority. Owing to the all-embracing interpretation of the term "factory," there are one hundred and forty-five premises in the Department's Register. The definition includes such premises as boot and shoe repairers, cycle and radio repair shops and all premises, however small, where articles are made, repaired, altered or adapted for sale (to quote just a small part of a very long definition). Comparatively few of this number are of any size. The supervision of "workplaces" is carried out by the Local Authority under the provisions of the Public Health Act, 1936. The name "outworker" is applied to persons carrying out certain classes of work at their houses and the employer, i.e., the occupier of the factory, is required to supply to the District Council, every six months, lists containing the names and addresses of such persons. None of the local factories employ outworkers resident in this district, but a certain number of our residents are employed by factories in other areas. When a case of infectious disease is notified at an outworker's home, steps are taken to ensure that there is no risk of infection being conveyed by the articles made thereat. It is incumbent upon the Health Department of the Local Authority to approve, among other things, the general health provisions, overcrowding, temperature, ventilation and drainage of floors and to keep a register of all factories and to be in close touch with the Factory Inspectors under the Ministry of Labour and National Service. Smoke Abatement. Twenty-three inspections and observations were made in connection with the emission of smoke from chimneys. There were no offences in this connection. Shops Act. There are 652 shops recorded in the district and, during the year 1950, 154 inspections were made. In only three cases was it necessary for the Committee to issue Informal Notices to enforce compliance with the Shops Act. 27 As a result of action taken by the inspectors, additional sanitary accommodation was provided in seven cases, heating of shop improved in one case, lighting improved in two cases and proper hand-washing facilities provided in 23 cases. In four cases the shopkeeper was required to provide seats for female assistants. In seven cases shop-keepers were found not to be keeping, exhibiting or providing the necessary notices or records as required by the Act. Rodent Control. On the 31st March, 1950, the Rats and Mice (Destruction) Act, 1919, was repealed, and its place taken by the Prevention of Damage by Pests Act, 1949. This Act is designed to make permanent provision for preventing loss of food by infestation and one of its most notable modifications is that the local authority may now, if they consider it expedient, after a seven-day notice, carry out rat destruction work on premises which are suitably grouped for " block control," recovery of expenses reasonably incurred being made at a later date. The delay occasioned by consulting the various interested parties and the time and trouble taken to persuade the invariable back-slider is thus avoided and further damage to valuable foodstuffs stopped. Owing to their quick rate of breeding, one of the most important factors in keeping down the rat population is the early notification of infestation to the Health Department. Prevention by the occupier is best secured by denying access to food and not providing suitable harbourage for breeding. The year's figures shew a further increase in the number of occupiers who have availed themselves of the rodent control service provided by the Local Authority. During the year, infestation was notified at 452 premises, of which 387 were found infested by rats and 62 by mice. One thousand, three hundred and thirty-eight inspections were made by District Sanitary Inspectors to 647 premises. Three hundred and eighty-eight premises were treated for rats and 42 for mice. A whole-time rodent operative has been engaged since 1941. In addition to work carried out at owner's or occupier's expense in dealing with rodents on private property, he has also undertaken similar duties on the properties in the possession of the Council, including sewers. During the year he has made 5,187 visits in connection with the work of eradicating rodents. In order to discover the extent of the sewer rat infestation, the regulation " One in Ten" test was made on sewer manholes. Of the 129 manholes selected and baited, only 22 showed "takes," which indicates a reasonably satisfactory state of affairs. During the year, two six-monthly treatments were carried out on the sewers and the first 28 treatment, where 61 manholes, including those showing "takes" under the test, were baited and in 31 cases the baits were taken. The second treatment, where 53 manholes were baited, showed 15 "takes." Verminous Conditions and Uncleanliness. The continued low incidence of verminous conditions and uncleanliness is a source of gratification, particularly taking into consideration the housing shortage and the consequent overcrowded conditions in which so many families are living. It is surely a measure of our success over many years in educating the public in the principles of cleanliness, that conditions fostered by dirt have declined to such an extent as to be almost negligible. It would probably be true to say that in the majority of cases of uncleanliness, the condition has arisen as a result of old age or illness and not to neglect of the elementary principles of hygiene in healthy, able-bodied people. During the year, 31 complaints were received of infestation of premises by bed bugs. This shows a continued low number of complaints and it appears that bed bug infestation is well under control. The number of houses and/or their contents found to be infested was 11 (including two in the Council's possession). In suitable cases, and on the request of the tenant and owner, the disinfestation of the premises and contents were simultaneously carried out by the Department. In all other cases the premises were disinfested by the owners, and the contents by the occupiers. In all necessary cases, bedding was steam disinfected by the Department. The usual method of disinfestation is to spray with D.D.T. fluid. Close supervision was made of premises which had been disinfested, and the tenants were given suitable advice and instruction on methods of prevention and destruction of vermin. 29 SECTION E HOUSING 30 SECTION E. HOUSING. New Houses. The year saw the near completion of the London County Council St. Paul's Cray Estate of 1,487 houses. In addition to these there were 56 houses erected by private builders and eighteen by the Local Authority. There were no pre-fabricated dwellings erected during the year, nor have there been any demolition or clearance areas. Rehousing by Local Authority. The following information has been supplied by the Housing Manager: — Prior to 1950 During 1950 1. (a) No. of "permanent" dwellings built by Local Authority 652 18 (b) No. of pre-fabricated dwellings built by Local Authority 275 Nil (c) No. of dwellings requisitioned by Local Authority 261 Nil (d) No. of emergency hutments 46 Nil (e) Halfway houses 5 1 2 (a) No. of families occupying la) 652 18 (b) No. of families occupying 1 (b) 275 275 (c) No. of families occupying 1 (c) 416 410 (d) No. of families occupying 1 (d) 41 44 (e) No. of families occupying 1 (e) 24 26 3. Total number of families rehoused during 1950 in (a) 34 (a), (b) and (c) (b) 12 59 4. Number of families on waiting list at June, 1950: — Families requiring 5 bedrooms 2 Families requiring 4 bedrooms 65 Families requiring 3 bedrooms 427 Families requiring 2 bedrooms 644 Families requiring 1 bedroom 449 Old Age Pensioners 56 Applicants not yet married 35 1678 In addition to the figure of 1,678, approximately 400 new applications are awaiting classification. Moveable Dwellings. Three hundred and eight inspections were made of sites at Chalk Pit, Ruxley; Old Brickfield, Church Road, Footscray ; Twysdens Meadow, Cray Road, Footscray ; and Corkes Meadow, Leesons Hill, where there are accumulations of moveable dwellings. 31 There are two camps of Fruit Pickers' Huts which were in use during the year and of which 13 inspections were made. There is an increasing use being made of moveable dwellings (caravans, etc.) by persons other than of the so-called gipsy type, for the purposes of permanent housing, owing to the restrictions made on private building and to the present-day high costs and the shortage of houses generally. Many families prefer living in a caravan to sharing limited accommodation in a house built for one family. The powers under the Public Health Acts to control permanent caravan sites and moveable dwellings are very limited, and it has now become more a matter of applying, in the early stages of their establishment, the provisions of the Town Planning Acts. Overcrowding. The position, so far as is known with regard to overcrowding as defined in the Housing Act, 1936, is shown in the following table: — 32 OVERCROWDING. Ward. No. of cases at 31st December, 1950. 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Number of cases found during the year. Number of cases remedied during year. Number of cases. No. of persons concerned. Aged over 10. No. of persons concerned. Aged under 10. Lamorbey E 4 2 4 6 7 9 6 7 11 9 5 — 3 2 4 12 Lamorbey W Longlands — — — 1 — 1 1 1 - - - - - - Birchwood — 1 1 1 Frognal — - - 1 1 i 1 1 - - - - - - North Cray 1 1 1 1 1 1 1 i 3 1 1 i St. Paul'- Cray 1 1 1 2 4 5 6 4 5 3 3 5 2 2 1 n Chislehurst Common 1 1 1 1 3 6 3 1 1 1 1 1 6 Mottingham 3 2 2 2 4 5 15 6 15 26 17 5 9 13 22 84 Totals 10 7 9 13 18 21 30 24 42 43 27 7 16 18 28 115 33 SECTION F INSPECTION AND SUPERVISION OF FOOD 34 SECTION F. INSPECTION AND SUPERVISION OF FOOD. Byelaws for securing the observance of Sanitary and Cleanly Conditions and Practices in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, have been adopted by the Council and came into force during 1950. Generally speaking, the task of improving the hygiene of food premises has been made relatively easy by the willing co-operation of managers and owners, but in the few cases where standards are low and there is little evidence of willingness to improve, the Food Byelaws will be of great value, particularly as they enable the Local Authority to deal with the actual offender (viz.: the Assistant), instead of the person in charge of the business. Not infrequently, the fault lies with the customer who not only handles food exposed for sale, but is not unknown to be careless of the owner's property. Inspection of Food Premises (Restaurants, Hotels, Canteens, etc.). Following the extensive survey of food preparing premises during 1949, the inspectors made a further 443 visits and there is evidence of continued improvement. They found no gross infringement of the Byelaws which were adopted during the year. Food and Drugs Act, 1938-1950. One hundred and twenty formal and 58 informal samples were taken during the year. Details of these samples appear in the appendix and all samples proved to be genuine except: — Beef Sausages—Deficient 26 per cent, minimum amount of meat. Beef Sausages—Sulphite 160 parts per million. Lemon Curd—Contained no egg. Lemon Curd—Contained no egg. Biscuit (Malted whole wheat)—Contained very small black particles having appearance of ash. Warnings were given in all cases. Unsound Food. 5 tons, 5 cwts. 2 qtrs. 5 lbs. of unsound food were surrendered as unfit for human consumption and destroyed or used, where possible, for animal food after suitable treatment. A list of this condemned food will be found in Appendix 4. No food exposed for sale was found to be unsound during the year. 35 Complaints. Fifty complaints of unsound food came to the notice of the Department. Thirty-six were brought to the office by members of the public, three came to attention from other sources and 11 were referred to other districts. Of the 39 complaints dealt with by the Department, thirteen were reported to Committee, three needed no further action, nine required warnings to be given to shopkeepers and one case was brought before the Court and there was a successful prosecution. Slaughterhouses. There is one slaughterhouse recorded on the register of the Local Authority. No animals were slaughtered and no applications for licences to slaughter animals under the Slaughter of Animals Act, 1933, were received. Under Food Control Regulations, the slaughtering of animals is carried out centrally. No pigs were slaughtered in the district in 1950. Butchers' Shops. There are 50 retail butchers' shops in the district, and in no case was there unsound meat exposed for sale. Two hundred and sixtyseven inspections were made. Piggeries. There are 20 piggeries in the district, to which 159 visits were made during the year. Fifteen defects were found and remedied. Bakehouses and Bakers' Shops. There are 11 bakehouses in the district and a total of 192 visits were made to these and bakers' shops during the year. Twelve defects were found and remedied during 1950. Fishmongers and Fish Frying Premises. There are 14 premises in which fish frying is carried on and six inspections were made. Six defects were found and remedied. Milk. Following the change of legislation whereby the Ministry of Agriculture and Fisheries became responsible for the execution and enforcement of regulations relating to dairy farms, the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, was introduced at the end of the year and came into force on the 1st January, 1951. The object of this Act is to consolidate the enactments relating to milk, dairies and artificial cream. Thirty-four visits were made to the 16 dairies registered in the Urban District and the following Licences were issued in respect of the sale of milk having a special designation: — 36 Tuberculin Tested Dealers' Licences 15 Supplementary Licences 11 Pasteurised Dealers' Licences 16 Supplementary Licences 12 Sterilised Dealers' Licences 20 Supplementary Licences 11 Ice Cream. At the end of the year there were 126 premises registered for the sale of, and one for the manufacture of, ice cream. Three hundred and forty-eight visits were paid to these premises, and a total of 97 samples were submitted for bacteriological examination. No pathogenic organisms were found to be present in any sample. The Methylene Blue tests resulted as follows: — Grade I 48 Grade II 18 Grade III 29 Grade IV 2 97 37 SECTION G INFECTIOUS DISEASES 38 SECTION G. INFECTIOUS DISEASES. The control of infectious diseases necessitates prompt exchange of information between the authorities concerned, and it is a matter for gratitude that during the course of the year the liaison between the Medical Officer of Health and the Hospitals has been built up and strengthened. By virtue of arrangements made during the course of the year, the Hospitals keep me informed of any case of infectious or suspected infectious disease which may occur in institutions under their control. For our part, we keep the Hospital authorities, doctors, schools, etc., apprised of all important developments on the infectious disease front, thereby enabling them to be on the look-out for the particular infectious diseases which may be rampant at any particular time. These arrangements would be especially valuable should an outbreak of a serious infectious disease, for example, smallpox or enteric fever, occur. Anterior Poliomyelitis. In view of the large and widespread epimedic of infantile paralysis which occurred in the country in the latter part of the year, we were indeed fortunate to have only 27 cases, of which 13 were paralytic. Last year's outbreak was distinctive in that many widely separated districts had a large number of cases leaving extensive intervening areas relatively unaffected. Critical analysis of this peculiar distribution would rather lead to the conclusion that, spread out over the country, there are, at certain times of the year, quite virulent foci of infection. If we take as an example two neighbouring towns A and B of similar type and of more or less equal population and find that in A there are a large number of cases, while in B only two cases occur, the reasonable inference appears to be that a large number of people in town A have come into contact with the focus of infection in that town, whereas in town B only those who visited A have exposed themselves to the risk of infection. This theory would do a lot to explain the fact that case to case infection appears to be very rare, for example, the unusualness of more than one case in a household and the fact that hospital staffs are not particularly prone to the disease. Unfortunately we are still floundering in the dark as to possible foci of infection and, although many ingenious theories have been advanced, I still adhere, in the present state of our knowledge, to the view that human carriers are the most likely sources of infection. Before leaving the subject, a word should be added about immunity. At present we have no test to determine whether or not an individual is susceptible to infantile paralysis. It may well be that the majority of people have a natural immunity to the disease, which could explain 39 why only one person in a household is usually affected, but if this is so, the increased number of cases in the community of recent years can only be explained by the fact that there are more foci of infection now than there were formerly. This might well be the case, with the increased inter-continental travel of modern days, by means of which healthy carriers could import the disease into this country from other countries where it is endemic. From the above remarks, it will be clear that, although the problem of anterior poliomyelitis is as yet unsolved, there are lines of approach which, it is hoped, will bring forth fruit in the not too distant future. Smallpox. This disease is no longer endemic in the British Isles, but owing to the modern speed of travel there is always a risk of its being imported into this country. It is perfectly possible for a person to be a contact of smallpox, for example, in India, to fly to this country and to develop the first signs of illness after being here for several days. If such a sequence of events happened and the patient has been in addition partially immune to smallpox, he might well be insufficiently ill to consult a doctor. In such circumstances, the disease could be spread to a large number of persons before its presence had been suspected, particularly if the population as a whole were not immune. In view of this it will be clear that constant vigilance is necessary on the part of all concerned, if the importation of smallpox on a big scale is to be avoided ; every day's delay in the control of movement of a case increases the danger of an epidemic. As the Council are aware, there were two or three instances of smallpox being brought into this country during the past year, but they must all be considered to have been very well controlled. In view of this ever-present potential risk, it is the practice of the department to urge the necessity for frequent vaccination of all those members of the staff who, through the nature of their work, would be especially exposed to the risk of contracting smallpox, should an outbreak occur in this district. Owing to the difficulty of differentiating smallpox from chickenpox and other diseases, any weakening of the link between the Medical Officers of Health, General Practitioners and Hospitals, would increase the risk of the spread of smallpox. I am happy to say this link is locally a strong one. All contacts of smallpox cases which occurred in other parts of the country and who became residents in the district, were kept under daily surveillance for the necessary period of sixteen days. No cases developed among these contacts. 40 Vaccination. The following figures, which have been furnished by the County Medical Officer, show the number of persons who were vaccinated against smallpox during the year 1950: — Age to 31.12.50. Under 1. 1 to 4. 5 to 14. 15 or over. Total. Number Vaccinated 443 364 64 45 916 Number Re-vaccinated — 7 43 150 200 Scarlet Fever. Two hundred and seventy-five cases were notified (196 during 1949), of which 153 were treated in hospital and 122 home nursed. There were ten return cases. The infection continued to be mild in character and no deaths from this disease were recorded. The continued lack of seriousness in the symptoms of this disease in the majority of cases, gives just cause for gratification, but whether this is a temporary or permanent feature will only be able to be judged with the passage of time. If one studies the incidence and life history of scarlet fever over many years, it is a striking fact that there have been periodical waves of alternating seriousness and mildness, and it may well be that we are now in the trough of the wave with the crest to be found at some future date. Whether this present attenuation is due to a building up in the resistance of the population or to a weakening in virulence of the infecting organism is not clear, but whatever the cause, the future of this disease will need constant vigilance. Diphtheria. Although six cases of suspected diphtheria were admitted to hospital, they were not confirmed and the continued absence of this disease gives cause for considerable gratification. The diphtheria immunisation campaign is still being kept up, but despite this, there is still quite a large percentage of children who have never been immunised. It is, therefore, impossible to say that immunisation is the only factor concerned in the control of this disease. Diphtheria Immunisation. During the year 1950, a total of 755 children received Primary Inoculations and 513 Reinforcing Inoculations. A total of 10,661 children under the age of 15 years had completed a course of immunisation (since 1st January, 1936), at the 31st December, 1950. This is equivalent to approximately 54 per cent. of the population under 15 years of age. 41 Measles. Three hundred and thirty-eight cases occurred in the district during 1950, as against 935 cases for 1949, giving an attack rate of 4.2 per 1,000 population. Four of these cases were admitted to hospital and the remainder were home nursed. The distribution of the cases occurring was fairly even throughout the area. The incidence of this disease almost invariably follows a predictable course, for being so very infectious, the great majority of those not immunised by a previous attack develop it in a time, of epidemic. Thus, after a large outbreak we expect to be relatively free until the next lot of susceptible children become exposed to the risk of infection when they also will contract measles, thus providing the next epidemic. The inter-epidemic cases are made up from the susceptibles who somehow missed being attacked during the epidemic and from those who contract the disease more than once—an uncommon occurrence in the case of measles. The vast majority of cases occurring during 1950 were mild in character and it does seem that, providing there is good home hygiene and that very young children are not infected, most of the terrors of this illness have been overcome. Nevertheless, if carelessness of treatment of the child infected occurs, there is always danger of complications arising and these are often followed by prolonged debility. Whooping Cough. Four hundred and sixty-one cases were notified during 1950, as against 230 for 1949, giving an attack rate of 5.8 per 1,000 population. Fourteen of these cases were admitted to hospital, and there were no deaths. There was a rise in the incidence of this disease compared with the previous year, but it would be incorrect to draw any conclusions from the number of notifications of an illness which has always shown inconsistent variations. It is, however, pleasant to be able to record that, like measles and scarlet fever, this disease appears to be of a mild type generally speaking at the present time, and what has been said about measles with reference to hygiene and avoidance of the disease in very early life, applies very much in this case also. Immunisation against Whooping Cough is still, unfortunately, in the experimental stage, and there is no statistical evidence to prove its efficacy, but one is constantly coming across individuals who are of the opinion that it saved their own children either from having the disease at all or, at very least, modified the attack considerably. Such "evidence" if, of course, inadmissible and as yet immunisation against whooping cough on a large scale cannot be advocated. 42 Tuberculosis. The three appendices, 6, 7 and 8, give statistical facts of tuberculosis in Chislehurst and Sidcup. The increase of cases on the register is due to two main facts: — (a) The priority given to T.B. families in the selection of tenants for the London County Council St. Paul's Cray Estate. (b) The greater facilities for and the advance in the diagnosis of the disease in the early stages. If one looks more deeply into the incidence of cases notified for the first time since 1937, it will be seen that there is little change year by year. It is true an incidence of 1.02 per 1,000 in 1937 has become an incidence of 1.23 in 1950, but this is probably due to the greater facilities for diagnosis and the readiness of general practitioners to notify such cases. If the population of Chislehurst and Sidcup had remained stationary over the years since 1937, it is very doubtful indeed whether the statistics would have shown this apparent increase of incidence. From the appendices it will also be seen that in 1950 the number of cases increased by 396, only 99 of which were new, the remainder being transferred cases from London. It will be interesting to watch the effect of the new environment of Chislehurst and Sidcup upon these transferred cases. The coming of the Mass X-Ray unit in the early months of 1951 will tend to increase the incidence for that year, as it will bring to light some cases in the early stages of the infection which, perhaps would not have been diagnosed for some years to come. That the notification of this disease is a correct standard on which to base the incidence in Chislehurst and Sidcup is shown by the fact that there were no deaths from tuberculosis which had not been previously notified. Food Poisoning. There were 46 cases of Food Poisoning notified during the year, 31 of which were single cases. Of this 31, three cases were caused by an agent identified as Salmonella Typhi-Murium, and in the remaining 28 cases the cause was unknown. There were three outbreaks involving 15 people. The great difficulty in regard to investigation of food poisoning notifications is that unless they are notified by 'phone, they are received too late for practical investigation into the cause. Suspected food has been destroyed, and stool specimens taken too late. It follows that the statistics do not give a true picture—more cases are certainly being notified but only a small percentage can be proved. Fortunately, none of the outbreaks were severe, either in extent or character. Only one case was admitted to hospital. 43 Dysentery. Last year, only two cases of Dysentery were notified—a number which has increased to 21 during 1950. These have been of the mild Sonne type, but it has been noticed that there has been a tendency to an increase in the notifications of this disease in other districts of which I am Medical Officer of Health. The explanation of this rise in the incidence of this disease is not clear, but it is a condition which, if it gains a foothold in any community, will spread very rapidly despite the most rigid public health control measures. General. The following table gives a summary of infectious diseases notified during the year: — Disease. No. of cases notified. Scarlet Fever 275 Puerperal Pyrexia 4 Acute Poliomyelitis 27 Respiratory Tuberculosis (Male) 52 Respiratory Tuberculosis (Female) 42 Other forms of Tuberculosis (Male) 2 Other forms of Tuberculosis (Female) 3 Pneumonia 44 Whooping Cough 461 Measles 338 Erysipelas 13 Dysentery 21 Typhoid Fever 1 Malaria (contracted abroad) 1 Food Poisoning 46 Of the notified cases of acute Poliomyelitis, 13 were paralytic and 14 non-paralytic. The following details relate to cases of infectious disease admitted to hospital during the year: — Disease. Lennard Hospital. Others. Diagnosis not confirmed. Scarlet Fever 153 — 1 Acute Poliomyelitis 23 5 8 Cerebro-spinal Meningitis 1 — 1 Diphtheria 6 — 6 Whooping Cough 12 2 1 Measles 2 2 1 Dysentery 3 — 2 Typhoid Fever 1 — — Paratyphoid 1 — 1 Pneumonia — 6 — Pneumonia and Whooping Cough 2 — Puerperal Pyrexia 2 - Meningitis — 1 1 Food Poisoning 1 45 SECTION H OTHER SERVICES 46 SECTION H. OTHER SERVICES. Inspection of Nursing Homes. The district is fortunate in that it has a number of excellent Nursing and Maternity Homes, but full use is not being made of the facilities offered, as, with the advent of the National Health Service Act, most people are unwilling and unable to afford to pay the fees which, like most other things, are tending to rise. This is indeed a tragedy when one considers the number of people urgently requiring treatment or care who cannot be accommodated by the Hospital Board or by the County Council. The only practical solution appears to be for the Hospital Board and the County Council each to take over some of the empty beds and to pay the Nursing Home proprietors an agreed figure for taking on their responsibilities. On the other hand, with the current shortage of money and the drive for economy, both the above authorities may find a financial barrier to any expansion in this direction. The district now has seven registered homes—one more than during the previous year—and thirteen visits have been paid to them during the course of the year. There were no serious infringements of the Byelaws and the service offered was, in all cases, up to the required standard. Health Education. Early in the year a meeting was held in the Council Chamber to which were invited proprietors of cafes, restaurants, etc. The problems of the caterers were thrashed out and a frank exchange of views obtained between the caterers and the Public Health Department. As a result of this meeting it was decided to give a film show, followed by a lecture and discussion on the problems of clean food handling. This took place in the Council Chamber in May, and was well attended and appreciated by both the management and staff sides. The following month the whole performance was repeated at one of the school halls for the benefit of the school canteen workers and was again very well attended. These two efforts supplemented and stressed the continuous propaganda and educational work being undertaken by the department, but in the ordinary way the work is naturally of a much more individual nature. It would appear that nothing but good can eventuate from our efforts, but the tree grows slowly and will take some years to fruit fully. In addition to the above, Mr. Allen arranged a series of films on matters of health interest one evening in October. The Central Office 47 of Information provided the films and appropriate local organisations were invited to be present. Public Conveniences. The Health Department is responsible for the cleansing of the conveniences. Public Mortuary. This has been much used during the year. The work involved at the mortuary is erratic and demands a constant readiness for the reception and post-mortem examination of bodies. On many occasions there has been more than one body—sometimes as many as five at one time. The extension and refrigeration facilities provided in 1949 have proved invaluable and have been the subject of favourable comment by doctors and others using the mortuary. A small, but very satisfactory improvement has been the "viewing lobby," in which relatives can see a body without having to go into the post-mortem room as heretofore. 49 APPENDICES. 1. SANITARY INSPECTION—INSPECTIONS AND PLAINTS. 2. FACTORIES ACT, 1937. PART I. PART II. 3. FOOD AND DRUGS. SAMPLES TAKEN DURING 1950. 4. UNSOUND FOOD. FOOD CONDEMNED. 5. WATER SUPPLY. BACTERIOLOGICAL EXAMINATION RESULTS. 6. TABULATION OF TUBERCULOSIS RATES. 7. TABULATION OF 1950 TUBERCULOSIS QUARTERLY RETURNS. 8. TUBERCULOSIS—1950 AGE GROUPS. 9. SCHEDULE OF COMMONS, PARKS AND OPEN SPACES. 50 APPENDIX 1. 1. INSPECTIONS—General. A total of 13,098 inspections were made during the year, as follows: — 7,493 to dwelling houses (Public Health Acts). 204 „ dwelling houses (Housing Acts). 192 „ bakers. 267 „ butchers. 443 „ cafes, restaurants and canteens. 34 „ farms, dairies and cowsheds. 175 „ fishmongers. 201 „ greengrocers. 336 „ grocers. 159 „ piggeries. 348 „ premises re ice cream. 70 „ other food preparing premises. 42 „ factories with mechanical power. 164 „ factories without mechanical power. 1,338 „ premises for rats and mice. 475 „ cases of infectious disease—general. 69 „ cases of infectious disease—tuberculosis. 308 „ moveable dwellings. 13 „ pickers' huts. 23 „ premises in connection with smoke abatement. 154 „ shops. 314 in respect of unsound food. 13 to rivers and streams. 263 miscellaneous. 13,098 2. COMPLAINTS. One thousand one hundred and seventy-five complaints were received and investigated. Where necessary, appropriate remedial action was taken. Summary of complaints received: — 377 re general sanitary defects. 6 „ keeping of animals. 54 „ offensive accumulations. 31 „ verminous premises. 286 „ drainage. 6 „ water supply. 278 „ rats and mice. 44 „ overcrowding. 39 „ food. 27 „ dustbins. 6 „ smoke. 21 „ miscellaneous. 1,175 51 APPENDIX 2. FACTORIES ACT, 1937 and 1948. Part I. 1. Inspections for Purposes of Provisions as to Health. Premises. Number on Register. Number of Inspections. Written Notices Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 14 42 15 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 126 148 29 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 5 16 — — Total 145 206 44 — i.e., Electrical Stations (Section 103 (i)), Institutions (Section 104), and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 52 APPENDIX 2 (cont.) 2. Cases in which defects were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more " cases "). Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied. Referred To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 5 5 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): (a) insufficient 8 8 — — — (b) unsuitable or defective 16 16 — — — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to out-work) — — 4 5 — Total 29 29 4 5 — 53 APPENDIX 3. FOOD AND DRUGS: Samples taken during 1950. During the year a total of 178 samples of food and drugs were taken, the results being as follows: — Articles. Formal. Informal. Apple conserve 1 1 Baking powder 5 1 Biscuit — 1 Black pudding 1 — Brawn 1 — Bread, butter and cheese — 1 Butter — 1 Butter mints 1 — Butter scotch 1 — Candy scotch 1 1 — Caraway seeds — Catarrh lozenges 1 — Coffee — 1 Coffee and Chicory Essence 2 ! Cough linctus — 1 Cough mixture 1 — Custard powder 1 — Crab paste 1 — Doughnuts 1 1 Fish paste with tomato 3 1 Fish Cakes 1 — Ginger, crystalised 1 — Golden raising powder 1 — Honey 5 — Horseradish sauce 1 — Ice cream — 6 Iodised throat lozenges — 1 Jam 2 — Lemon curd 5 1 Lemonade powder 1 — Lung syrup 1 — Lung tonic 1 — Macaroni 1 — Meat Pies 2 31 Milk 9 Milk, condensed — 1 Nutmeg, ground — 1 Oranges, tinned — 1 Pastry Mix 1 — Peas, dried 1 — Peanut butter — 1 Peppermints 1 — Pepper flavoured compound 1 — Pickles 1 — Pineapple, crystalised 1 — Pork brawn 1 — Rum and butter sweets 1 — Sage and onion stuffing 1 — Salad cream 2 — Sausages, beef 28 2 Sausage, luncheon 1 — 54 Articles. Formal. Informal. Sausages, pork 15 — Sausage meat, pork 1 — Sausage meat, beef 4 — Sugar wheat puffies 1 — Sweets 1 2 Sweet almond oil 1 — Tea 1 — Vinegar 3 — Vinegar, malt — 1 120 58 55 APPENDIX 4. UNSOUND FOOD—CONDEMNED. Item. Condition. tons. cwts qrs. lbs. Apples bruised 18 Bacon unsound 2 14 Barley Flakes mites 2 4 Beef bone taint, etc. 5 3 23 Beef tuberculosis 1 2 21 Butter unsound 1 Cake rancid, etc. 3 10 Canned baked beans containers blown, perforated or punctured, etc. 20 „ chocolate spread „ „ „ 2 „ fish „ „ „ 1 — 9 „ fruit „ „ „ 12 1 11 „ fruit juice „ „ „ 1 „ ham decomposed 14 „ jam containers blown, perforated or punctured, etc. 3 21 „ marmalade „ „ „ 2 4 „ meat „ „ „ 6 3 10 „ milk „ „ „ 1 10 2 8 „ Mincemeat „ „ „ 14 „ mint sauce „ „ „ 2 „ paste „ „ „ 26 „ peas „ „ „ 2 15 „ pudding „ „ „ 2 „ soup „ „ „ 2 16 „ spaghetti „ „ „ 10 „ syrup „ „ „ 12 „ tomatoes „ „ „ 19 „ treacle „ „ „ 2 „ vegetables „ „ „ 7 — 23 Cereals vermin infested 2 2 27 Cheese decomposed 2 4 Dates infested 2 1 20 Eggs, fresh decomposed 1 11 Eggs, frozen „ 1 — Fat „ 8 Figs „ 3 7 Fish „ 13 1 23 Flour contaminated 3 13 Fondant „ 13 Horseradish unsound 3 Jam contaminated and fermented 13 Junket unsound 2 Lamb decomposed 3 24 Margarine „ 1 Mayonnaise unsound 12 Milk, dried „ 1 Mustard damp 5 Mutton decomposed 1 23 Oatmeal unsound 1 12 Oats vermin infested 1 — Pastry mix unsound 2 Pickles decomposed 1 11 Poultry unsound 4 56 V Item. Condition. tons. cwts qrs lbs. Powder, custard decomposed 1 Prunes ,, 3 — 15 Puddings ,, 1 — 22 Rabbits ,, 1 — 22 Salad cream ,, 1 9 Sandwich spread ,, 8 Sauce ,, 2 Sausages ,, 1 — 26 Tea mouldy 1 5 5 2 5 57 APPENDIX 5. RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLY TO CHISLEHURST AND SIDCUP U.D.C. FOR 1950. Parts per Million (unless otherwise stated). Description of the Sample No of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Nitrate Clorides as CL Oxygen abs. from Permanganate 3 hrs. at 80° F Turbidity in termsof Silica Colour m.m, brown 2ft. tube Burgess Tintometer Hardness (Total) Hardness (Permanenfc) pit Value Phosphate as P.O. Silica as Si02 Conductivity Orpington well 3 .007 .023 5.9 15.0 .09 — 0 276 42 7.4 — — 475 North Orpington 3 .008 .030 5.5 15.3 .14 .30 0 265 41 7.2 — — 425 Shortlnnds 4 .004 .025 4.3 18.6 .13 — 0 298 90 7.2 — — 475 Eynsford 4 .005 .020 3.3 17.6 .09 20 1 275 56 7.4 — — 450 Bexley 5 .006 .031 5.3 19.3 .09 — 2 291 69 7.2 — — 450 Wilmington 4 .023 .034 7.0 22.0 .12 — 0 292 67 7.2 — — 500 Darenth 4 .008 .028 4.8 17.0 .09 .05 3 274 57 7 3 — — 450 Thames-derived — filtered water 1687 .018 .091 4.1 26 5 1.18 .20 15 271 82 7 9 .39 11.0 475 BACTERIOLOGICAL RESULTS. Percentage of samples negative to Bact. coli in a 100 ml. Bact coli per 100 ml. Orpington well 253 99.6 .004 North Orpington 241 100.0 Nil Shortlands 256 100.0 Nil Eynsford 352 99.7 006 Bexley 217 100.0 Nil Wilmington 248 100.0 Nil Darenth 256 100.0 Nil Thames derived filtered water 3602 99.9 002 58 APPENDIX 6. TUBERCULOSIS IN CHISLEHURST AND SIDCUP. (as corrected by Inward and Outward Transfers). Year Ending Population Chialthurst and Sidcup U.D. Notifications Number of Cases on Register Pulm. Non-Pulm. Pulm. Non-Pulm. Total Number of yearly increase Number per 1,000 pop. M F M F Dec. 1937 58,678 54 6 109 96 43 25 273 S3 4.3 1938 61,750 32 8 114 104 50 28 296 25 4.8 1939 63,160 48 18 135 106 57 35 333 37 5.2 1940 63,650 58 10 153 106 56 40 355 22 5.5 1941 60,610 64 15 169 122 65 41 397 42 6.5 1942 60,400 * 73 12 191 128 54 43 416 19 6.8 1943 60,130 77 15 200 140 51 45 436 20 7.1 1944 57,470 81 6 194 177 51 42 464 28 8.9 1945 59,170 58 13 201 194 56 47 498 34 8.4 1946 67,870 78 15 231 217 61 51 560 62 8.2 1947 70,580 81 3 253 241 58 51 603 43 8.5 1948 72,750 114 5 308 301 60 51 720 117 9.8 1949 73,510 86 9 399 395 64 55 913 193 12.4 1950 80,040 94 5 583 587 73 66 1,309 396 16.3 *War years. Evacuation period. 59 APPENDIX 7. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Quarterly Statement of Cases on Notification Register, 1950. Quarter Ended 31st March, 1950 30th June, 1950 30th September, 1950 31st December, 1950 Pul. N. Pul. Total Cases Pul. N. Pul. Total Cases Pul. N.Pul. Total Cases Pul. N.Pul. Total Cases (a) No. of cases of Tuberculosis on the Register at the commencement of the Quarter M F M F M F M F M F M F M F M F 399 396 64 65 913 436 436 67 58 997 485 491 71 62 1109 529 533 72 66 1200 (b) No. of cases notified under the Public Health (Tuberculosis) Regulations for the first time during the Quarter 9 8 1 — 18 13 10 11 2 26 11 6 — — 17 19 18 — 1 38 (c) No. of cases restored to the Register during the Quarter — — — — — 1 1 — — 2 — — — — — 1 — — — 1 (d) Other additions to Register during the Quarter 34 39 2 3 78 44 53 3 2 102 38 41 1 4 84 43 48 2 — 93 (e) No of cases removed from the register during the Quarter 6 6 — — 12 9 9 — — 18 5 5 — — 10 9 12 1 1 23 (f) No. of cases remaining on the Register at the end of the Quarter 436 436 67 58 997 485 491 71 62 1109 529 533 72 66 1200 583 587 73 66 1309 60 APPENDIX 8. URBAN DISTRICT OF CHISLEHURST AND SIDCUP. Number of Cases Notified under the Public Health (Tuberculosis) Regulations, 1930, for the First Time during Year ended 31st December, 1950, according to Age-Groups. Age Group Qtr. ended 31.3.50 Qtr. ended 30.6.60 Qtr. ended 30.9.50 Qtr. ended 31.12.50 Totals for year 1950 Totals Pulm. NonPulm. Pulm. NonPulm. Palm. Noil Pulm. Pulm. NonPulm. Pulm. Non-Pulm. Pulm. Non-Pulm Male Female 0-Yrs. M — — — — 1 — 2 — 3 — — — 3 F — — — — — — — — — — — — 1-Yrs. M — — — — 1 — — — 1 — — — 2 F — — — — — — 1 — — — 1 — 3-Yrs. M — — — — — — — — — — — — 1 F — — — — — — 1 — — — 1 — 5-Yrs. M — — 1 1 2 — 1 4 1 — — 7 F 1 — 1 — — — — — — — 2 — 10-Yrs. M — — 1 — — — 1 — 2 — — — 4 F — — — — 2 — — — — — 2 — 15-Yrs. M 4 — 5 — 1 — 3 — 13 — — — 25 F 1 — 5 — 1 — 4 1 — — 11 1 25-Yrs M 4 1 6 — 4 — 9 — 23 1 — — 43 F 5 — 3 2 2 — 7 — — — 17 2 45-Yrs. M 1 — — — 2 — 3 — 6 — — — 14 F 1 — 1 — 1 — 5 — — — 8 — Totals 17 1 23 3 17 — 37 1 52 2 42 3 99 61 APPENDIX 9. SCHEDULE OF COMMONS, PARKS AND OPEN SPACES. Location. Acreage. Description. Abbeyhill Park. 6.84 Part allotments. Belmont Lane Open Space. 5.59 Part allotments. Beverley Avenue. 1.64 Open space. Chalk Wood and Mount Misery. 69.21 Open space. Chislehurst Recreation Ground and Whytes Woodland. 15.02 Open space with 4 tennis courts, 1 football pitch and 1 cricket pitch. Church Lane Recreation Ground. 2.25 Open space. Footscray Common. .70 Open space. Footcray Recreation Ground. 6.80 Open space and part allotments. Hollyoak Wood Park. 11.61 Open space and part allotments. King George's Field. 11.10 Open space with 3 football pitches, 2 cricket pitches and 2 concrete cricket practice pitches. Lamorbey Park. (1) The Glade. 10.63 Open space. (2) Land! fronting Burnt Oak Lane. 2.00 Open space. (3) Land leased. 12.42 Open space. Longlands Recreation Ground. 6.00 Open space with 1 football pitch and 1 netball pitch. Marlborough Park. 6.32 Open space with 1 football pitch and 1 netball pitch. Mottingham Sports Ground. 30.00 Open space with 3 tennis courts, 8 football pitches, 6 cricket pitches, 1 hockey pitch and 3 concrete cricket practice pitches. Mottingham Recreation Ground. 5.89 Open space. Old Farm Park. 11.78 Open space and part allotments. Parish Wood. 6.73 Open space. Penhill Open Space. 17.10 Open space with 3 football pitches and 2 cricket pitches. River Cray Reservation. (1) North Cray Place Farm. 29.60 Used for agricultural purposes. (2) Footscray Place Estate. 49.32 Open space. St. Paul's Cray Recreation Ground. 6.20 Open space with 4 tennis courts, 1 football pitch. 62 Location. Acreage. Description. Sidcup Place. 25.31 Open space with 1 cricket pitch and 1 putting green. Stable Meadow Sports Ground. 17.45 Open space with 2 football pitches and 1 cricket pitch. The Oval. 1.66 Open space. Walden Manor. 4.60 Open space. Waring Park. 13.06 Open space with 4 tennis courts, 2 cricket pitches, 1 putting green, 2 netball pitches and 1 concrete cricket practice pitch. Willersley Park. 5.59 Open space with 2 tennis courts. 392.42 Commons. The Chislehurst and St. Paul's Cray Commons have an area of approximately 165 acres and are administered by a Board of Conservators.